Pilot Study Using Oral Capsule FMT to Decolonize GI CRE

Early Phase 1WithdrawnNCT03527056

University of California, Los Angeles

Overview

Carbapenem-Resistant Enterobacteriaceae (CRE) are bacteria that have become resistant to carbapenems by producing enzymes that break down carbapenems. The prevalence of CRE continues to rise globally but the treatment options are extremely limited. In case series, isolation of CRE from any site, whether there is clinical infection or not, has been associated with all-cause hospital mortality ranging from 29% to 52%. There are no known methods for reliably decolonizing gastrointestinal (GI) CRE. In rare case reports, fecal microbiota transplant (FMT) has successfully eradicated gastrointestinal colonization of CRE, but there has been no larger study further investigating this. FMT via oral capsules is the least invasive method and has demonstrated efficacy and short-term safety in treating patients with recurrent Clostridium difficile infections. Therefore, the investigators propose this pilot study to determine the effectiveness of oral capsule fecal transplantation in the decolonization of gastrointestinal CRE.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Conditions

Enterobacteriaceae Infections Fecal Microbiota Transplantation

Interventions

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Outpatient * Have intestinal carriage of CRE Exclusion Criteria: * Pregnant * Peripheral WBC \>12 x 10\^9/L and/or temperature \>38 degrees Celsius * Swallowing dysfunction or known chronic aspiration * Delayed gastric emptying * History of intestinal obstruction * Active CRE infection * Acute exacerbation of underlying comorbid condition * Severely immunocompromised patients * Inflammatory bowel disease * Allergies to ingredients Generally Recognized as Safe * Adverse event attributable to previous FMT * Concomitant antibiotic use or antibiotic use 48 hours before FMT

Outcomes

Primary Outcomes

Proportion of participants with CRE decolonization at day 10 (+/- 3 days) after fecal transplant

CRE decolonization is defined by absence of CRE on stool culture using standard clinical laboratory techniques. Stool samples will be collected 10 days after FMT.

Time frame: 10 days

Proportion of participants with an adverse event through day 10 (+/- 3 days) after FMT

Telephone calls are made to participants 10 days after FMT to assess for adverse event, severe adverse event, and adverse events of special interest (newly acquired transmissible infectious diseases).

Time frame: 10 days

Secondary Outcomes

Proportion of participants with CRE decolonization at month 1 (+/-5 days) after FMT

CRE decolonization is defined by absence of CRE on stool culture using standard clinical laboratory techniques. Stool samples will be collected 30 days after FMT.

Time frame: 1 month

Proportion of participants with CRE infection at day 10 (+/-3 days) and month 1 (+/-5 days) after FMT

CRE infection will be defined as an associated bacteremia, urinary tract infection, wound-related infection or other clinical infection deemed to be CRE associated at the discretion of the treating physician.

Time frame: 1 month

Proportion of participants with an adverse event, severe adverse event, or adverse events of special interest through month 1 (+/-5 days) after FMT.

Telephone calls are made to participants 1 month after FMT to assess for adverse event, severe adverse event, and adverse events of special interest (newly acquired transmissible infectious diseases).

Time frame: 1 month

Proportion of participants with a severe adverse event at month 6 (+/-14 days) after FMT.

Telephone calls are made to participants 6 months after FMT to assess for severe adverse event.

Time frame: 6 months

Proportion of participants with microbial engraftment assessed by microbiome disruption index (MDI) (MDI-community and MDI-species) measured by 16s ribosomal RNA at time of enrollment, day 10 (+/-3 days) and month 1 (+/-5 days) after FMT

Stool samples collected at baseline before FMT, day 10 after FMT, 1 month after FMT will be sent for 16s sequencing.

Time frame: 1 month